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Nurses – no more handshakes

As Nurses we offer handshakes to meet patient’s expectations and to develop a rapport with them. In developing countries such as India, shaking hands has become common, especially in the large cities among nurses and other health care workers dealing with patients.1, 2 Ritualistic touching plays a crucial role in many cultures. Though handshakes give a profound impact in better patient outcomes, it also has the potential for greater efficiency of pathogen transmission, and handshakes are known to transmit bacteria.3,4In India though significant advances have been made in infection control, inadequate practices and surveillance systems persist and there is often a high risk. Several food borne disease outbreaks have been reported which are associated with poor personal hygiene. The US Centers for Disease Control and Prevention says that one in 25 hospitalized patients develop an HAI and 75,000 patients with HAIs die during their hospitalization each year. Scientists at Aberystwyth University in Wales have shown that a shake transfers more bacteria compared to other forms of hand-on-hand action. Health care providers like nurse’s hands spread potentially harmful germs to patients that leads to healthcare-associated infections (HAI) i.e., infections acquired in health care also called as “nosocomial” and “hospital” infections.7According to WHO, out of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one health care-associated infection. The endemic burden of HAI is also significantly higher in low as well as middle income than in high-income countries, in particular in patients admitted to intensive care units and in neonates.5

So what next? Will fist bumps (also called dap, pound, fist pound, brofist, donsafe, spudding, fo’ knucks, box, Bust, pound dog, props, Bones, respect knuckles, bumping the rock, or knuckle crunching) replace handshakes in the hospital or any public places? Fist Bumps are basically an urban form of greeting one another by the bumping of fists together, meant as a form of respect.

When you do a fist bump, a smaller amount of surface area is in contact between the two hands. According to a new study “Fist bumping” transmits less bacteria than either handshaking or high-fiving while still addressing the cultural expectation of hand-to-hand contact among patients nurses and clinicians.6A British study has found that high-fives pass less germs as the traditional greeting and the fist bump is even cleaner.7In an another study the West Virginia researchers found that the individuals who shook hands had four times as many pathogens on their hands as the individuals who fist-bumped, according to results published last year in the Journal of Hospital Infection.8

There have been calls in the Journal of the American Medical Association to ban handshakes from hospitals and make it a global best practice.9American Medical Association, suggested that hospitals, clinics and other healthcare facilities post signs with messages as “Handshake-free zone: to protect your health and the health of those around you, please refrain from shaking hands while on these premises.”10

If we go back to the Victorian age; when on meeting someone you bow or curtsy from a respectful distance . NURSES – NO MORE HANDSHAKES. Next time you want to say “hi,” show off how casual you are with a friendly fist bump or just bow and say a Namasthe!

The question remains if healthcare facilities implement the fist bump and make it a global best practice.